News in brief: COVID-19 vax booster doses needed for some patients; Don’t miss Heart Health Checks; CTCA expansion has led to explosion in downstream testing

CTCA expansion has led to explosion in downstream testing

Computed tomography coronary angiography (CTCA) is being increasingly used for first-line chest pain investigation, but its expansion has led to an explosion in downstream testing — a phenomenon clinics should account for when growing their services, according to an Australian study.

The retrospective study of 1,460 patients undergoing CTCA at Frankston Hospital between 2015 and 2018 showed CTCA-use “steadily increased” from 59 patients to 395, 461 and 545 patients per year, respectively.

Downstream testing also increased from 11 in 2015 to 98 in 2018 — with 2, 60, 46 and 16 stress echocardiograms accompanying 0, 21, 29 and 18 myocardial perfusion scans per year, the authors wrote in the Journal of Medical Imaging and Radiation Oncology.

There were also 9, 37, 57 and 64 invasive coronary angiograms with 1, 13, 19 and 22 corresponding revascularisations per year, they added.

This growth in downstream testing “is an important consideration for health services that are starting or expanding their CTCA services with regards to resource planning”, they wrote.

Clinics will need to account for increased rates of functional testing, invasive angiography and revascularisation, they concluded.

Warning on missed preventative health assessments

Pandemic disruption has prevented tens of thousands of Australians from accessing preventative health assessments from their GP and this may result in many excess cardiovascular events, the Heart Foundation says

At least 27,000 fewer Heart Health Checks were conducted from March 2020 to July 2021, due to the impact of COVID-19, the Foundation says, and its modelling suggests these could have prevented 345 heart attacks, strokes or heart disease deaths over the next five years.

Lockdowns, as well as the resource-intensive roll-out of the COVID-19 vaccination program in GP practices, were linked to dramatic drops of up to 40 per cent in people having the check across the country, said Heart Foundation Chief Medical Adviser and interim Group CEO Professor Garry Jennings

“What we don’t want to see is a drop in heart health screening coupled with what we are seeing overseas as a result of the pandemic, in that people with heart attack symptoms are waiting longer to seek medical attention.

The Heart Foundation is promoting use of “The Toolkit which has been designed to streamline the assessment and management of CVD risk, reducing administrative burden, and allowing general practice to get the most out of financial and quality improvement incentives.

“It offers pre-populated assessment and management templates for Heart Health Checks that make it easier for GPs and practice nurses to collect CVD risk factor information and support patients,” said Professor Jennings.

COVID-19 vax booster needed for some patients: ATAGI

A third COVID-19 vaccine booster dose will soon be recommended for some Australians with immunocompromising conditions, according to the Australian Technical Advisory Group on Immunisation (ATAGI).

In advice released on 23 September, ATAGI said it anticipated that “a relatively small cohort of individuals, such as those with severely immunocompromising conditions, are likely to require a third dose as part of their primary course of vaccination to ensure optimal vaccine effectiveness.”

ATAGI added that boosters for other populations may be required in the future, and it was preparing recommendations to be released in the next few weeks.

Factors to be considered in recommendations for boosters include the duration of protection provided by additional doses, timing of booster doses to cover anticipated future peaks and the balance of efficacy and safety of third doses of mRNA vaccines, it said. ATAGI is also reviewing the types of vaccine to be used as boosters and the potential for newer  types such as the protein subunit vaccines variant vaccines as they become available.

In the meantime it said first and second dose coverage remained a priority for achieving protection in the current Delta outbreak.

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